AB0613 ETIOLOGY, OUTCOME AND PREDICTORS OF MORTALITY AMONG SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS PRESENTING TO EMERGENCY DEPARTMENT: A SINGLE CENTRE PROSPECTIVE STUDY
Authors: S. Kotwani, G. Naidu, M. Bhatia, S. Sharda, V. Dhir, S. K. Sharma, M. Rathi, A. Sharma, N. Sharma, S. Jain
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Systemic lupus erythematosus (SLE) patients can present to emergency department (ED) with acute manifestations that require immediate evaluation and initiation of appropriate therapy. The reasons for ED visits could be due to disease activity or various complications arising due to therapy. However, there is paucity of data on the reasons and outcomes of SLE patients who present to ED. <h3>Objectives</h3> To determine the reason, 3 month outcomes and the predictors of mortality among the SLE patients who present to ED. <h3>Methods</h3> Single centre prospective observational study was being performed between July 2021 and December 2022. Patients of SLE fulfilling the SLICC or the 2019 ACR/EULAR classification criteria and aged above 18 years and presenting to ED were included. Written informed consent was obtained from all the subjects. Clinical and laboratory details were noted at the time of presentation to ED. The reasons for ED visits were classified into disease activity or infection or both or non-SLE related. Outcomes of death and disease activity (by SLEDAI2K) at 3 months were noted. The study was approved by the Institute Ethics Committee. <h3>Results</h3> A total of 61 patients were included in the study. Median age was 28 years (IQR: 24-35) and 55 (90.2%) were females. Twenty (32.8%) patients were newly diagnosed with SLE after presentation to ED, and the median duration of illness among previously diagnosed patients was 24 months (IQR: 12-48). Disease activity alone (n=41; 67.2%) was the commonest reason for ED visit followed by disease activity co-existing with infection (n=15; 24.6%) and infections alone (n=5; 8.2%). Among the 56 patients with disease activity at presentation, active disease manifestations were noted in following organs: renal (57.1%), musculoskeletal (53.6%), skin (51.8%), haematological (42.9%), serositis (39.3%), neurological (28.6%), cardiac (26.8%), gastrointestinal (14.3%) and lung (5.4%). Among the 20 patients with infections at presentation, lower respiratory tract infections were the commonest, seen in 7 (35%) patients followed by CNS infections (15%). UTI, skin and soft tissue, ear and sino-nasal and sepsis with un-identified focus were seen in 2 (10%) patients each. Infective colitis and bacterial peritonitis were identified in 1 (5%) patient each. At 3 months of follow up, 21 (34.4%) patients died, with majority (n=18; 85.7%) dying within 1 month of presentation. Deaths were significantly more in patients who presented with both disease activity and infection compared to patients who presented with only disease activity or infection (p=0.0001). Among the remaining 40 patients, 15 (37.5%) were in remission, 13 (32.5%) were in low disease activity and 12 (30%) were in moderate to high disease activity. On multiple regression analysis, presence of hypoxia (p=0.046), serum albumin less than 2.5g/dl (p=0.006) and infection (p=0.001) at presentation predicted mortality at three months (Table 1). <h3>Conclusion</h3> The commonest cause of ED visit by SLE patients is disease activity alone followed by disease activity and co-existing infections. Infections were present at the time of ED admission in one-third of SLE patients. Three month mortality rate was high (34.4%) and presence of hypoxia, low serum albumin and infection at presentation predicted mortality at three months. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.